Beyond the Diagnosis: An Integrated Perspective on Strategic Dosing in Neurologic Motor Rehabilitation. A Scoping Review and Collaborative Viewpoint.

Authors

Ahmad Rifai Sarraj, Jihan Allaw, Fadi Zein El Abidin, Antonio Pinti

Published in

NeuroRehabilitation. Pages 10538135261470437. Aug 17, 2026. Epub Aug 17, 2026.

Abstract

BackgroundCurrent neurorehabilitation often relies on static, diagnosis-driven protocols or generic exercise administration, contributing to suboptimal long-term outcomes. There is a clinical need for a cohesive, mechanism-based framework to guide therapeutic reasoning, dosing, and longitudinal adaptation.MethodsA scoping review of neurorehabilitation literature was conducted according to PRISMA-ScR guidelines to map evidence on dosing, intensity, and longitudinal management. From 9,373 records, 42 studies were synthesized. The literature did not converge on standardized dosing parameters but supported a broad distinction between higher-intensity approaches for non-progressive conditions and more conservative, energy-conserving strategies for progressive conditions. Integrating these findings with author consensus, we developed a collaborative viewpoint proposing a hypothesis-generating clinical framework.Proposed FrameworkWe conceptualize three dynamic clinical pillars: (1) Optimization of Motor Performance, targeting behavioral restitution of activities of daily living through experience-dependent neuroplasticity; (2) Maximization of Motor Performance, promoting active neuroprotection in early degenerative diseases and structural compensation in stable lesions through high physiological effort; and (3) Preservation of Remaining Functions, prioritizing energy conservation and reduction of secondary sequelae in rapidly progressive conditions. The evidence supports the broad progressive versus non-progressive dosing distinction, while the three-pillar structure, FITT-PRO profiles, and transition triggers remain hypotheses requiring validation.Clinical ApplicationA preliminary decision-support structure is proposed around FITT-PRO parameters and longitudinal reassessment. Transition triggers, such as biological plateaus or exacerbations, are not yet operationally defined and require prospective biomarker-based validation.ConclusionThis framework differentiates conditions by functional responsiveness rather than diagnosis, supporting interdisciplinary prognostic reasoning while requiring prospective validation before clinical implementation.

PMID:
42606315
Bibliographic data and abstract were imported from PubMed on 17 Aug 2026.

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